Supporting a healthy dyadic lifestyle following a myocardial infarction using eHealth technology

Abstract

Problem In the current care pathway for patients suffering from a Myocardial Infarction (MI), a paradox has been identified in long-term chronic care: modification of cardiovascular risk factors reduce mortality and prevent recurrent cardiac events. However, MI survivors rarely change their lifestyle and relapse often in old habits. The identified cause within the system is a gap created by a lack of professional and social adherence support in relation to cardiovascular risk management. Research has shown how social support from a partner can improve lifestyle change adherence. To fill the gap, this study looks at how the patient's partner can be supported and empowered by the healthcare system to positively fulfill this role. Therefore, this strategic design thesis aims to develop a tangible strategy for the Hart Long Centrum of the LUMC by answering the following research question: "How can partners of chronically ill patients, that suffered from a MI, provide effective and positive support for the patient to maintain long-term preventive lifestyle changes by means of an eHealth innovation linked to The Box?” Dyadic Opportunity The partner of the patient is able to influence the patient’s health behaviour and motivation through the dyadic nature of their relationship. Therefore, a new perspective has been identified for 'The Box' to stimulate long-term preventive lifestyle change; using positive dyadic communication and support to influence the illness perception of patients and partners. This offers the opportunity to create a parallel track to bridge the chronic care gap. The track will be next to the current care pathway, in the form of an eHealth intervention that complements the existing 'The Box' innovation. Dyadic Experience Each individual in a couple, who have experienced a MI, goes through their own grieving process after a life changing event such as transition from a ‘normal life’ to a chronic illness. Within this process it has been shown that the needs of the partner and patient change over time. This dyadic adaptation process has been examined and the dynamic key needs of the partner have been identified: •How can the partner support the right way at the right time? •How can the partner themselves be supported? •How to strive for a relationship where the right balance between ‘patient’ and ‘loved one’ is achieved during the adaptation process? Solution Direction A future solution is envisioned in which the patient's partner is actively given a central role in participating in long-term lifestyle change: Partners will be empowered and guided by the healthcare system, by means of an eHealth intervention driven by hybrid intelligence and P4 mechanisms (prevention, prediction, personalization, participation), to positively support the patient in the right way at the right moment in changing their lifestyle in the long term. WeCAIR - Partner Perspective of the Hybrid Intelligence Portal (HIP) To make the strategy of influencing patient adherence by empowering and guiding the partner tangible, WeCAIR is designed. WeCAIR is part of a Hybrid Intelligence Portal (HIP) which monitors and guards the balance of human dynamic interactions and needs between partner, patient and care professional. WeCAIR is a user-friendly interface developed from the perspective of the patient's partner. As discussed in the chapter before, the interface has three different main features: (1) Personalized Dyadic Route, (2) Behavioural Support and (3) Lifestyle Education. These characteristics are aimed at empowering and guiding the partner to take on a balanced role in relation to their life partner (the patient) in the adjustment process to chronic illness, in order to positively support the patient in the right way at the right moment in changing their lifestyle in the long term. Conclusion The proposed strategic Product Service System (PSS) improves the current care pathway by involving, supporting and empowering the partner in the care process, resulting in long-term adherence to lifestyle changes. Ultimately, this leads to secondary prevention for the patient and primary prevention for the patient's partner. For the LUMC Hart Long Centrum, this means that by implementing the PSS they will be one step closer to their goal of providing the best clinical and innovative care to patients.